Project Summary Heart failure (HF) is the fastest growing cardiovascular disorder in the United States and continues to be associated with high morbidity and mortality. Recognition of symptoms is a critical factor in the diagnosis and treatment of HF because symptoms are key drivers of hospitalizations and health-related quality of life (HRQOL). Our ability to predict who will experience more burdensome symptoms is hindered by the lack of association between objective markers of heart function and symptoms. A critical gap in our knowledge of HF symptom biology is how pulmonary congestion, an objective measure of HF pathophysiology, is related to HF symptoms, self-management behaviors and HRQOL. Accordingly, the overall goals of this study is to determine the association of pulmonary congestion that is detected by devices used in the clinical management of HF with physical symptoms of HF and HRQOL and to examine the role of self-management in moderating the relationship between device-detected congestion, symptoms and quality of life. Employing a longitudinal design and integrating data remotely downloaded from implanted defibrillator/pacemakers and data collected via survey in a cohort of 60 adults with symptomatic HF, we will address two specific aims: 1) quantify the association between device-detected congestion with both HF symptoms and HRQOL and 2) determine the influence of HF self-care management on the relationship between device-detected congestion and HF symptoms and HRQOL. This innovative study will be the first to examine associations between pulmonary congestion and physical HF symptoms and the first to determine the role of patient self-care management in moderating the relationship between device-detected congestion, HRQOL and symptoms of HF. Furthermore, as a research proposal supported by a National Research Service Award, this study will contribute to the development of the applicant into an independent nurse scientist with an influential program of study focusing on biological and behavioral foundations of HF symptoms. The proposed study and training plan integrate the combined clinical and analytic expertise of a well-established interdisciplinary team. This proposed fellowship research and training plan is well-aligned with the mission and goals of National Institute of Nursing Research through the focus on symptom biology, self-management behaviors, and the development of influential and independent nurse scientists.